AEGiS-15IAC: The evaluation of racial/ethnic disparities in the implementation of a syringe deregulation law in Rhode Island, USA.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

The evaluation of racial/ethnic disparities in the implementation of a syringe deregulation law in Rhode Island, USA.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1111)

Macalino GE, McNamara S, Sanford-Colby S, Case T, Zierler S
Brown University Medical School, Providence, RI, United States

BACKGROUND: Access to clean syringes has been shown to be a powerful HIV prevention effort among injection drug users. Recently, a policy intervention was adopted in Rhode Island to allow for over-the-counter purchase of syringes. We sought to determine if racial/ethnic disparities existed by purchaser experience.

METHODS: We developed a purchaser trial to collect field data on the sale of syringes in retail stores by the 3 main racially 'visual' groups in RI-white, black and Hispanic. 3 cities were chosen based on their populations of primarily black, Hispanic, and white residents. All pharmacies in these cities were visited in a stratified random order by each of the gender/racial purchaser types (n=6). Hired purchasers 'differed' only based on visual gender and racial characteristics. Purchasers were blinded to the racial component of the study.

RESULTS: Purchasers experienced barriers to accessing syringes in 6 of the 38 pharmacies (16%) (i.e., either by being told that syringes weren't sold there or sold only in boxes of 100 (prohibitive by cost). None of the 6 pharmacies gave all purchasers the same reason for non-sale and in 5 of 6 cases, the differing response was given to a racial/ethnic purchaser (e.g., in 2 pharmacies, the black male was told that syringes were not sold there while the other purchasers were told they only sold boxes of 100). 2 pharmacies differentially sold syringes with prohibitive cost being the barrier to sale for 1 white male (purchase attempt from a male clerk compared to other purchaser attempts from a female clerk) and 1 black female. Pharmacies differed by minimum number of syringes sold and while cost per syringe within a pharmacy tended to be similar, the cost per syringe differed widely between pharmacies (range: USD$0.15-$6.49).

CONCLUSIONS: These data reflect clerk and/or store discretion determining access to clean syringes despite statewide law change. Law implementation needs to be included in evaluating HIV policy interventions.

Keywords: AEGIS, Syringes, Substance Abuse, Intravenous, Pharmacies, Acquired Immunodeficiency Syndrome, HIV Infections, Rhode Island, HIV Seroprevalence, Substance-Related Disorders, Costs and Cost Analysis, Female, Male, legislation & jurisprudence, economics, methods

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